Abstract
BackgroundIn the quest for public and private resources, prevention continues to face a difficult challenge in obtaining tangible public and political support. This may be partly because the economic evidence in favour of prevention is often said to be largely missing. The overall aim of this paper is to examine whether economic evidence in favour of prevention does exist, and if so, what its main characteristics, weaknesses and strengths are. We concentrate on the evidence regarding primary prevention that targets cardiovascular disease event or risk reduction.MethodsWe conducted a systematic literature review of journal articles published during the period 1995–2005, based on a comprehensive key-word based search in generic and specialized electronic databases, accompanied by manual searches of expert databases. The search strategy consisted of combinations of freetext and keywords related to economic evaluation, cardiovascular diseases, and primary preventive interventions of risk assessment or modification.ResultsA total of 195 studies fulfilled all of the relevant inclusion criteria. Overall, a significant amount of relevant economic evidence in favour of prevention does exist, despite important remaining gaps. The majority of studies were cost-effectiveness-analyses, expressing benefits as "life years gained", were conducted in a US or UK setting, assessed clinical prevention, mainly drugs targeted at lowering lipid levels, and referred to subjects aged 35–64 years old with at least one risk factor.ConclusionFirst, this review has demonstrated the obvious lack of economic evaluations of broader health promotion interventions, when compared to clinical prevention. Second, the clear role for government to engage more actively in the economic evaluation of prevention has become very obvious, namely, to fill the gap left by private industry in terms of the evaluation of broader public health interventions and regarding clinical prevention, in light of the documented relationship between study funding and reporting of favourable results. Third, the value of greater adherence to established guidelines on economic evaluation cannot be emphasised enough. Finally, there appear to be certain methodological features in the practice of economic evaluations that might bias the choice between prevention and cure in favour of the latter.
Highlights
In the quest for public and private resources, prevention continues to face a difficult challenge in obtaining tangible public and political support
The purpose of this article is to examine the main characteristics, weaknesses and strengths of the existing evidence regarding economic evaluations of primary prevention, i.e., the prevention of disease before it occurs for the first time, including health promotion, screening for risk factors and risk factor modification through clinical prevention efforts
Based on empirical analyses of the published literature, we describe and summarize the quantity, content and type of existing health economic evidence in relation to diseases, interventions and health care systems that has been generated so far. These results should provide indications as for areas in which evidence is scarce or even absent. To allow for both a comprehensive overview and more in depth analysis, the review is divided in two parts: 1) In a first step, we identified all full economic analyses that evaluated primary prevention activities aiming at reducing the burden of cardiovascular diseases
Summary
In the quest for public and private resources, prevention continues to face a difficult challenge in obtaining tangible public and political support This may be partly because the economic evidence in favour of prevention is often said to be largely missing. We concentrate on the evidence regarding primary prevention that targets cardiovascular disease event or risk reduction. We concentrate on the evidence regarding primary prevention targeting cardiovascular disease (CVD) event or risk reduction. By focusing on CVD prevention we are able to capture a set of the risk factors that account for the largest share of the disease burden in Europe, such as tobacco consumption, high blood pressure, high body mass index, and physical inactivity
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